3D打印结合影像三维融合技术指导退行性脊柱侧弯患者个体化手术的疗效研究  

Research on the Efficacy of 3D Printing Combined with Image Fusion Technology to Guide Individualized Surgery for Patients with Degenerative Scoliosis

作　　者：刘兴勇 刘臻 沙鹏[1] LIU Xingyong;LIU Zhen;SHA Peng(Department of Orthopedics,Xuzhou Cancer Hospital,Xuzhou,Jiangsu 221000,China;Department of Spinal Surgery,Nanjing Drum Tower Hospital,Nanjing,Jiangsu 210000,China)

机构地区：[1]江苏省徐州市肿瘤医院骨科,江苏徐州221000 [2]江苏省南京市鼓楼医院脊柱外科,江苏南京210000

出　　处：《转化医学杂志》2024年第9期1454-1459,共6页Translational Medicine Journal

摘　　要：目的探讨3D打印结合影像三维融合技术术前评估及手术入路指导个体化手术对退行性脊柱侧弯患者疗效的增效作用。方法前瞻性选择2017年1月2023年1月徐州市肿瘤医院收治的130例退行性脊柱侧弯患者,按照数字表法随机分为2组,其中对照组(n=65)给予传统椎弓根钉内固定手术,研究组(n=65)予以3D打印结合影像三维融合技术辅助个性化椎弓根钉内固定手术。比较2组围手术期相关指标、功能恢复情况[Oswestry功能障碍指数(ODI)、日本骨科协会胸腰椎评分(JOA)]、影像学参数[冠状面Cobb角、冠状位平衡偏移距离(CBD)、矢状位平衡偏移距离(SVA)、胸椎后凸(TK)和腰椎前凸(LL)]和疼痛情况[疼痛视觉模拟评分(VAS)],并记录术后并发症发生率。结果研究组置钉时间、术中出血量、输血量和置钉透视次数低于对照组(P<0.05);研究组术后3个月JOA评分高于对照组(P<0.05),ODI评分低于对照组(P<0.05);术后3个月研究组冠状面Cobb角、SVA、CBD低于术前(P<0.05),LL高于术前(P<0.05),TK与术前比较差异无统计学意义(P>0.05);研究组VAS评分低于对照组(P<0.05);研究组并发症发生率低于对照组(P<0.05)。结论3D打印结合影像三维融合技术术前评估及手术入路指导个体化手术可提高退行性脊柱侧弯患者治疗疗效,促进功能恢复,减轻疼痛症状,降低术后并发症发生率。Objective To investigate the clinical efficacy of individualized surgery using 3D printing combined with image fusion guidance for preoperative assessment and surgical approach selection in patients with degenerative scoliosis.Methods A total of one hundred and thirty degenerative scoliosis patients admitted to Xuzhou Cancer Hospital from January 2017 to January 2023 were prospectively enrolled and classified into two groups according to different surgical procedures,each with 65 cases.The control group received conventional pedicle screw internal fixation,while the study group underwent 3D printing and image fusion-assisted individualized surgical guidance for pedicle screw placement.Perioperative indicators,functional recovery[Oswestry Disability Index(ODI),Japanese Orthopedic Association(JOA)score],imaging parameters[Cobb angle,coronal balance distance(CBD),sagittal vertical axis(SVA),thoracic kyphosis(TK),lumbar lordosis(LL)],pain degree[Visual Analogue Scale(VAS)],and postoperative complication rates were compared between the two groups.Results The study group reported shorter screw insertion time,less intraoperative blood loss,lower blood transfusion volume,and fewer intraoperative fluoroscopy instances compared to the control group(P<0.05).At postoperative 3 months,the study group scored higher on JOA(P<0.05)and lower on ODI(P<0.05)compared to the control group.Imaging analysis showed significant reductions in Cobb angle,SVA,and CBD(P<0.05)and an increase in LL(P<0.05)in the study group,with no significant change in TK before and after surgery(P>0.05).The study group also reported lower VAS scores(P<0.05)and a reduced complication rate(P<0.05)compared to the control group.Conclusion Application of 3D printing combined with image fusion-assisted surgical guidance in degenerative scoliosis patients can significantly promote functional recovery,alleviate pain symptoms,and reduce postoperative complications.

关 键 词：打印 三维 影像融合 退行性脊柱侧弯 疗效 疼痛 并发症 

分 类 号：R682.3[医药卫生—骨科学]